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Impact of rheumatologic diseases on pediatric inflammatory bowel disease
Duygu Demirtaş Güner1, Erdal Sağ2, Hayriye Hızarcıoğlu Gülşen1
1Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Insights
Rheumatologic diseases (RD) affect over 30% of pediatric inflammatory bowel disease (IBD) patients, with familial Mediterranean fever (FMF) being common. RD in pediatric IBD patients increases the need for biologic therapies.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Rheumatology
- Genetics
Background:
- Coexistence of rheumatologic diseases (RD) and inflammatory bowel disease (IBD) in children is not well understood.
- Assessing RD frequency and clinical impact in pediatric IBD is crucial for management.
Purpose of the Study:
- To determine the prevalence of RD in pediatric IBD patients.
- To evaluate the clinical impact of RD on disease activity and treatment in pediatric IBD.
Main Methods:
- Retrospective cohort study of pediatric IBD patients (November 2008 - December 2020).
- Compared demographic characteristics, disease activity, inflammatory markers, and treatments between IBD patients with and without RD.
- Specific analysis of the familial Mediterranean fever (FMF) subgroup.
Main Results:
- RD identified in 31.8% of pediatric IBD patients; FMF was most frequent (21.6%).
- Patients with RD showed lower disease activity at diagnosis but required more biologic therapy during follow-up.
- FMF subgroup had lower initial disease activity but higher activity at last follow-up compared to non-RD IBD patients.
Conclusions:
- RD, especially FMF, is prevalent in pediatric IBD, affecting over 30%.
- RD presence in pediatric IBD necessitates increased biologic therapy use, despite lower initial disease activity.
- Systematic screening for RD in pediatric IBD is recommended for personalized treatment, particularly in high MEFV mutation prevalence areas.
Background:
The coexistence of rheumatologic diseases (RD) and inflammatory bowel disease (IBD) in children remains underexplored. This study aimed to assess the frequency of RD and its clinical impact in pediatric IBD patients.
Methods:
This retrospective cohort study included pediatric IBD patients followed at the Department of Pediatric Gastroenterology, Hepatology and Nutrition at Hacettepe University, Ankara, Türkiye between November 2008 and December 2020. Demographic characteristics, disease activity scores, inflammatory markers, and treatment modalities were compared between patients with and without concomitant RD; an additional analysis was performed in the familial Mediterranean fever (FMF) subgroup.
Results:
A total of 88 patients (35 females, 53 males; median age 14.6 years) were analyzed. RD was identified in 28 patients (31.8%), with FMF being the most frequent (19/28, 67.9%; overall 21.6%). Although patients with RD had lower disease activity at diagnosis (p = 0.010), they required more frequent biologic therapy during follow-up (35.7% vs. 16.7%, p = 0.047). In the FMF subgroup, disease activity scores were significantly lower at diagnosis and higher at the last follow-up compared with patients without RD. There were no significant differences in inflammatory markers between the groups at diagnosis and last follow-up.
Conclusions:
RD, particularly FMF, is commonly observed in pediatric IBD, with a prevalence of 31.8% for RD and 21.6% for FMF. The presence of RD is associated with an increased need for biologic therapy despite lower initial disease activity. Children with IBD should be systematically evaluated for RD, especially in regions with high MEFV mutation prevalence, to support more personalized management strategies.
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